Research

1. King George medical
University
KGMU COLLEGE OF NURSING.
PRESENTATION
Evidence based practice in nursing
Presented by:-
ASHUTOSH KUMAR
MSc. Nursing 1st year

2. INTRODUCTION
• Evidence based practice is an approach that
enables clinician to provide the highest quality of
care in meeting the multiphase needs to their
parents and family.

3. Cont...
Evidence based practice

4. HISTORICAL OVERVIEW
• During 1980s the term ' Evidence based medicine '
emerged to describe the approach that used
scientific evidence to determine the best practice.
• Later the term shifted to become 'Evidence based
practice ' as clinician other than physician
recognised the importance of scientific evidence in
clinical decision making.

5. DEFINITION
• Evidence based practice in nursing is a process of
locating, appraising and applying the best evidence
from the nursing and medical literature to improve
the quality of clinical nursing practice.

6. AIMS OF EBP
• To provide the high quality care.
• To advance quality of care provided by health
workers.
• To increase satisfaction among patients.
• It results in better patient outcomes.
• It keeps practice current and relevant.
• It increases confidence in decision makin

7. PURPOSE OF EBP
• EBP is one approach that improves patient
outcome.
• EBP allows nurses to enrich their clinical training
and experience with up-to-date research.
• EBP is an approach that tries to specify the way.

8. Cont...
• Its goal is to eliminate unsound or excessively risky
practices in favour of those that have better
outcomes.
• EBP has contributed a lot towards better patient
outcome.
• The ultimate goal of EBN is to provide the highest
quality and most cost-efficient nursing care
possible.
• The purpose or utility of EBP in nursing is mainly to
improve the quality of nursing.

9. PROCESS OF EBP
• EBP process involves the five steps.

10. Step:-1
• Formulate a clear question based on clinical
problems.
• The source for formulating a question is generally
categorised into two broader classes.
• 1). Problem-based sources.- the health care
professionals get an idea about relevant question
for EBP from the clinical or risk assessment data,
such as data of quality improvement, risk
surveillance, benchmarking data, financial data,
recurrent clinical problems, etc.

11. Cont...
2). Knowledge-based sources: The health care
professionals may obtain knowledge of newer
evidences from the scientific journals, publications,
research conferences or EBP guide- lines published
by statuary bodies, which may enhance nursing care
practices.

12. Step:-2
• Literature review to search for the best available evidence: The
literature review for EBP must start with theoretical and clinical
articles to have an overview about the topic of concern, which
should be followed by well-known existing EBP guidelines, if any
available then should go for reading and critiquing the original
research articles. It is better to include high level of evidences for
review, such as meta-analysis and systemic reviews of randomized
control trials, original randomized clinical trials, etc. It must be
ensured that an extensive literature review is carried out including
electronically as well as non-electronically available literature.
However, the reviewer must be very careful about the facts given
in literature because sometimes an article appears to be precise
and factual on the surface but with further and much closer
examination, flaws can be found.

13. Cont...
• On the other hand, the article can be loaded with
opinionated and/or biased statements that could
taint the findings, thus lowering the creditability
and quality of the article. Time management is
another factor, which is very crucial for information
retrieval, and current and fresh
information/evidences are considered more
weighted than the older one

14. Step :-3
• Evaluating and analysing the strengths and
weaknesses of that evidence :- Use of rating
systems to determine the quality of the research is
crucial to the development of EBP.
• There are several rating scales proposed to
determine the validity, strengths, and weaknesses
of the available evidence, a comprehensive and
more practical rating scale derived from the work of
Guyatt and Rennie (2002), Harris et al. (2001), and
Melnyk and Fineout (2005).

15. Step :-4
• Implementing useful findings in clinical practice
based on valid evidence: Once study findings are
analysed for strengths, weaknesses, internal and
external validity, a decision is made about
appropriateness of evidence for the particular
question initiated for EBP.
• The final evidences must be extensively discussed
among the users with risk-benefit ratio of evidence
and extent and level of harms are involved with
particular evidence.

16. Step:-5
• Evaluating efficacy and performance of
evidences :- after the implementation of the useful
findings for the clinical practices, efficacy and
performance is evaluated through processes of self-
reflection, internal or external audit or peer
assessment.

17. BARRIERS IN EBP
• Overwhelming amount of information available in
the literature.
• Lack of professional ability to critically appraise
research.
• Lack of time, workload pressures, and competing
priorities of patient care can impede use of EBPS.
• Lack of knowledge of research methods is also one
of the significant barriers in promotion of EBPS.

18. Cont...
• Lack of support from professional colleagues and organizations,
and lack of confidence and authority in the research arena.
• Shortage of research in some areas of nursing.
• Lack of continuing education programmes for nurses in India,
especially for bedside nurses.
• Lack of initiatives among nursing leaders and managers to create
the environment of EBP practices in Indian scenario.
• Physicians' dominance in clinical practices, thus nurses are not
given autonomy to implement newer, better clinical nursing
evidences in practice.
• The lack of administrative support or incentives for
implementation of EBN practices.

19. Research abstract
• Translating research into practice: case study of a community- based
dementia caregiver intervention. (Mittelman MS, Bartels SJ.)
• Evidence from randomized clinical trials has demonstrated the
effectiveness of providing psychosocial interventions for caregivers to
lessen their burden. This case study describes outcomes of the
implementation of an evidence-based intervention in a multisite
program in Minnesota. Consistent with the original randomized clinical
trial of the intervention, assessments of this program showed decreased
depression and distress among caregivers. Some of the challenges in the
community setting included having caregivers complete the full six
counseling sessions and acquiring complete outcome data. Given the
challenges faced in the community setting, web-based training for
providers may be a cost-effective way to realize the maximum benefits
of the intervention for vulnerable adults with dementia and their
families.

20. SUMMARY

21. CONCLUSION
• Evidence-based nursing care is a lifelong approach to clinical
decision making and excellence in practice. Evidence-based
nursing care is informed by research findings, clinical
expertise, and patients' values, and its use can improve
patients' outcomes. Use of research evidence in clinical
practice is an expected standard of practice for nurses and
health care organizations, but numerous barriers exist that
create a gap between new knowledge and implementation
of that knowledge to improve patient care. Using the levels
of evidence, nurses can determine the strength of research
studies, assess the findings, and evaluate the evidence for
potential implementation into best practice.